For many families, a sudden hospital bill can be financially overwhelming. Health insurance is meant to be a safety net, but how reliable is it when the time comes to make a claim? One of the best ways to gauge an insurer’s reliability is by looking at the Claim Settlement Ratio (CSR)—a measure of how often a company actually pays out claims.
The Insurance Regulatory and Development Authority of India (IRDAI) releases an annual report showing claim settlement details for both life and general insurance companies. This is a crucial reference point for anyone considering an insurance policy.
Put simply, the Claim Settlement Ratio is the percentage of claims an insurance company settles compared to the total number of claims it receives in a given period. If an insurer has a CSR of 93%, it means that out of 100 claims submitted, 93 were approved and settled, while the rest were either rejected or are still pending. This ratio helps in understanding how smooth or challenging the claim process could be with a particular company.
The overall CSR for life insurance companies in India, including the government-run Life Insurance Corporation of India (LIC), stood at 96.82% for claims settled within 30 days. Meanwhile, private life insurers performed slightly better, settling 99% of claims within the same period.
In the case of general insurance, which includes health policies, the figures vary significantly between public and private sector players.
While a high claim settlement ratio suggests a company process claims efficiently, it’s not the only thing to consider. A company with a high CSR may still have a complex claim process, and a lower CSR doesn’t necessarily mean all claims were unfairly rejected. The key is to look at how quickly claims are settled, whether the insurer provides a cashless facility, and how transparent their claim process is.
At the end of the day, health insurance is supposed to offer peace of mind. Before choosing a policy, checking an insurer’s CSR, claim process, hospital network, and customer reviews could save policyholders from unpleasant surprises when they need support the most.
